150例糖尿病患者胰腺外分泌功能检测及相关因素分析

Evaluation of exocrine pancreatic function by assaying fecal elastase concentration and analysis of itsrelated factors in 150 patients with diabetes mellitus

目的探讨糖尿病患者胰腺外分泌功能不全的发生情况及其相关因素。方法选取2009年3月至2010年6月于第四军医大学西京医院内分泌科就诊的糖尿病患者150例，分为1型糖尿病组（T1DM，23例）、2型糖尿病组（T2DM，127例），对照组为来我院健康体检者及我科医护人员共48人。记录糖尿病患者的年龄、性别、体质指数（BMI）、病程、糖尿病微血管病变发生情况、糖化血红蛋白（HbAle）等指标。收集受试者24h内排出的粪便，应用酶联免疫吸附实验（ELISA）法测定粪便中粪弹性蛋白酶（FE）的含量，对所有受试者的胰腺外分泌功能进行评估。率的比较采用X2检验或Fisher精确概率法。结果1型糖尿病患者、2型糖尿病患者及对照组粪便FE含量差异有统计学意义[分别为（394±237）比（502±194）比（576±170）μg／g，F=6．93，P〈0．01]。以FE〈200μg／g作为胰腺外分泌功能不全的判断标准，结果显示30．4％（7／23）的T1DM患者及7．9％（10／127）的T2DM患者存在胰腺外分泌功能不全，与对照组（0）相比，差异有统计学意义（Fisher检验P〈0．05）。以是否存在胰腺外分泌功能不全对糖尿病患者进行分组分析，结果显示两组间年龄、性别、BMI、病程、胰岛素治疗与否、糖尿病微血管病变发生情况、稳态模型胰岛素分泌指数（HOMA-B）、空腹胰岛素、餐后2h胰岛素及HbAlc等差异均无统计学意义（均P〉0．05）。结论本研究提示与健康对照相比，T1DM和他DM患者胰腺外分泌功能不全的发生率普遍较高。

Objective To investigate the prevalence and related factors of exocrine pancreatic insufficiency in patients with diabetes mellitus （DM）. Methods A total of 150 patients including 23 with type 1 diabetes mellitus （T1DM） and 127 with type 2 diabetes mellitus （T2DM）, and 48 healthy controls from Xijing Hospital were enrolled in this investigation between March 2009 and June 2010. The clinical and laboratorial parameters such as age, gender, body mass index （BMI）, diabetes course, diabetic microvascular complications, glyeated hemoglobin Ale （HbAlc） of diabetic patients were recorded. Stool samples were collected for 24 hours. Exocrine pancreatic function was measured by assaying fecal elastase （FE） concentration by enzyme-linked immunosorbent assay （ELISA） in all the subjects. Categorical values were compared using either the X2 test or the Fisher exact test. Results The concentration of FE was significantly lower both in T1DM group （ （394 ±237） μg/g） and T2DM group （ （502 ± 194） μg/g） than that in control group （ （576 ± 170） μg/g） （F = 6. 93,P 〈 0. 01 ）. When the diagnosis criterion of exocrine pancreatic insufficiency was defined as FE 〈 200 μg/g, the results showed that higher prevalence of exocrine pancreatic insufficiency was found both in T1DM patients （30. 4% （7/23）） and T2DM patients （7.9% （10/127）） than that in control subjects （0） （ Fisher＇s P 〈 0. 05）. However, when the diabetic patients were divided into two groups 2 h postprandial insulin. significant statistic differences in gender distribution, with and without exocrine pancreatic dysfunction, no age, BMI, diabetes course, prevalence of diabeticmicrovascular complications and insulin medication, fasting insulin, 2 h postprandial insulin, homeosbasis model assessment of β cell function（HOMA-β） or HbA1 c were found between the two groups （P 〉 0. 05）. Conclusions Exocrine pancreatic dysfunction was in higher prevalence in T1DM and T2DM patients than that in healthy controls.